Santhosh G
PROCESS ASSOICATE I AUDITOR
ABOUT ME
An experienced Claim process and trainer able to explain information clearly, recognize excellence in individuals, and inspire team members to achieve their potential while toward common goals
CONTACT
Door# 3, Sathiyamoorthy street, New Perungalathur, Chennai - 600063, TN
acw7i6@r.postjobfree.com
Education
S.S.L.C From G.hr. Sec school, Perungattur
H.SC From G.hr. Sec school, Perungattur
B.E From Arunai Engg college, Tiruvannamalai
Adjudication
Adjudicate the Healthcare claims from leading third party insurance company in US
Accessing the members ‘and provider’s database
Validating the member’s history of eligibility in terms of name, age, dollar limit, lifetime maximum and other specific benefits with the respect
Validating the claims ‘provider/physician history and details
If any discrepancies are found in the claim, we will reject the claim and send them back to physician along with the rejection comment
Hobbies
Net Suffering
Reading news papers
Objective
I would like to obtain a position as a team-player in a people oriented organization where I can maximize my customer service experience in a challenging environment to achieve the corporate goal
Experiences
Company: SourceHOV
Role : Claim Processor
Year : 2013 to 2014
Place : Chennai
Company: Dell BPS
Role : Claim Sr Associate
Year : 2014 to 2015
Place : Chennai
Company: Accenture
Role : Claims Analyst and Claims Auditor
Year : 2015 to present
Tenure
Achievements
1st price in Chess Tournament held in my college
Received on the Spot Award 3 financial quarter
On 2014 I was awarded as Dell Business champion owing to handling the CBE transition successfully
Platform Experienced
OHI
Amisys
Facets
Work Culture
●Establishing and define the structure of learning content
●Facilitate the integration of content with the knowledge and experience of the trainees
●Having a call with onshore every week on clarifying the doubts
●Audit claim and track Error
●Feedback give processor relate to Error and Give training based on feedback to processor
●Conducting refresher sessions for the existing team members on every Friday and evaluate the team members, besides performance details would be shared to operation team.
●Being an Auditor I need to monitor the process documents on required basis and confirm with the onshore that we don’t have any ambiguities.
Language
English : Proficiency
Tamil : Expert
SKILLS
Communication
Problem solving
Team player
Data Management
Certification
CCNA
Dot Net
Clients
HPHC
United health care
BCBSNC